We have prepared for this issue a very brief editorial and I don't know how your time goes, but would you like me to read it or simply submit it?

Senator GOODELL. Why don't you submit it for the record and any important part that you wish to quote from, go right ahead. (The article referred to appears in the appendix.)

organs

Dr. SCHREINER. I might just mention that almost a decade ago the National Kidney Foundation discussed plans for issuing a donor card which would be a legal instrument for testamental disposition of that need to be rapidly harvested after death, and the kidney is a prime example of this in current medical practice. Our wise restraint prevented the execution of these plans and the reason was that a few State laws prohibited persons to dispose of all or part of his own body. Those States which did had unclear or different language so that no single interpretation would suffice.

This permitted only local distribution of donor cards which is impracticable in a highly mobile society. As you know, statistics show that the ideal age group which is under 50, 20 to 25 percent change their address each year.

With the technical advances in organ preservation and with the legal advances that have made possible passage of the Uniform Tissue Act in 40 States with testamentary disposition in another five, we thought that it is now practicable to go ahead. Therefore, we cooperated with the ad hoc group and our own National Executive Committee has authorized us to proceed with this distribution of the cards which I have shown you. We are actively proceeding in that direction.

At the present time we have maximum educational material that we can afford in order to try and get this into the largest number of hands as possible.

There is no question that there are thousands of people dying of kidney disease even in an area where there are transplant centers and that organ donation has been a significant bottleneck.

I assume that Dr. Hume already discussed the local network which exists and Georgetown is a part of this. We have, indeed, recently transplanted a kidney from a donor who died in Atlanta, Ga., at 5:45 a.m., and the kidney was placed in a commercial Delta Airline jet and the flight arrived in Washington National Airport at 7:25 a.m., and that kidney was making urine in a woman in Georgetown Hospital by 9 a.m.

This is a lady who had rejected two previous transplants and was very close to death. I am happy to say she was discharged from the hospital yesterday. I think this is an example of the working end of what has been made possible by the newer technology in transplantation.

All we can say is that we endorse this fully. I am delighted that you are taking the leadership from us, but I am sad that the Nation's Capital will be the 41st jurisdiction to do this. I would think that the Capital of our Nation would be the first to exercise medical leadership instead of medical followship.

This, of course, does not dilute the importance of your doing it, but I think it indicates how necessary it is to make up for lost ground. Thank you, sir.

Senator GOODELL. Do you have a statement, Mr. Smirnow?

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Mr. SMIRNOW. Mr. Chairman, I am Virgil Smirnow and I am executive director of the Kidney Foundation in the National Capital Area, an organization of national health voluntary organizations representing the interest of kidney patients and the residents of the area. The Kidney Foundation has asked me to present the following resolution, which they passed recently, for the record in connection with S. 2999, a bill to facilitate anatomical gifts after death in the District of Columbia.

RESOLUTION

The National Kidney Foundation of the National Capital Area, an affiliate of the National Kidney Foundation, supports and urges the passage of S. 2999. This measure would bring the District of Columbia into accord with 40 States which have passed identical legislation. In the case of chronic kidney disease, the Uniform Anatomical Gifts Act for the District of Columbia would provide a source of human kidneys for transplantation. These transplantation procedures have been demonstrated as life-saving measures and the passage of legislation which would facilitate donation of such human tissue and would indeed be the means of survival for such patients.

The Kidney Foundation estimates that more than 100 local residents each year would be suitable candidates for kidney transplants. At the present time these patients are not surviving except for a handful who can manage to secure transplant operations in other cities or can be kept alive on artificial kidney machines until the surgery can be performed locally.

The Kidney Foundation urges the Senate District of Columbia Committee to approve S. 2999 and to recommend passage by the Senate.

In addition to our formal resolution, I would like to make several observations, if I may. The initiation of transplant programs in the District of Columbia has been seriously impaired by the absence of the legal machinery whereby kidneys may be obtained during the very brief time interval when such tissue is viable following the death of the donor. Medical institutions in the National Capital Area are poised on the threshold of a kidney transplant program which would make this dramatic life-saving procedure available to many dozens of patients each year. A unique computerized regional tissue typing facility is being established at Georgetown University Medical Center to match donor and recipient kidney tissue as closely as possible. I understand George Washington University Medical Center is establishing a tissue-typing laboratory. Putting all of this sophisticated know-how to work saving lives is awaiting the availability of donor kidneys and donor kidneys can be available in sufficient numbers only if the law facilitates it. The present law does not. The legislation being proposed does.

Forty States have passed uniform anatomical gift laws. Some of the other jurisdictions will pass such legislation shortly. The District of Columbia is one of the few remaining jurisdictions which does not have such a law on the books. If we are to develop a kidney transplant capability in Washington area medical instututions, we must have a law which will facilitate the availability of donor kidneys and we believe that S. 2999 will accomplish this purpose.

In anticipation that the Senate, and also the House, will act favorably on this legislation, the Kidney Foundation is preparing an extensive and intensive kidney donor card program including supporting public interpretation materials so as to explain to the public the urgent need for donor kidneys and so as to encourage residents to sign and carry uniform donor cards. The Kidney Foundation is prepared to move ahead with this kidney donor program in the District of Colum

bia as soon as the Congress has acted and the President has signed the bill into law.

We know of no opposition to this legislation from any quarter. It has the acceptance of religions of all faiths. It has been designed and recommended by eminent members of the medical profession and scientists from the biological sciences. Area medical institutions endorse it ethusiastically. The public has accepted kidney donor programs without reservation in all other jurisdictions where such laws exist. We can honestly recommend this legislation to the committee as one involving no controversy whatever from any source and one which is vitally and urgently needed in order to accomplish a lifesaving purpose.

Thank you, sir.

Senator GOODELL. Dr. Schreiner, can you just briefly give us an example of a situation where this law could have been of assistance in making available organs saving lives?

Dr. SCHREINER. Yes, indeed. Transplantation is done in our study unit and there have been no charges to the 17 transplants that we have carried out to date. Eventually, obviously, there will be a proven form of therapy and the physician and the hospital will be entitled to the same kind of compensation that they get in any other surgical procedure of comparable lifesaving proportions, so I don't see any apologies for not charging for medical care. This is our system and until we have another system, this is the reasonable way of doing it. You asked a very interesting question earlier about religious objections. On our national advisory board we have Cardinal Sheehan, who is the ranking American U.S. cardinal of the Roman Catholic Church and Dr. William Wexler, who is vice president of B'nai B'rith, and I, myself, am on a committee for human rights, which is supported by the United Ministry for Higher Education, which is a group of Protestant churches that support this legislation.

We have had many, many opinions on problems involved in this area involving literally hundreds of hours that I have participated in and we have found no objections. In fact, I might, in answer to a question to your specific example that Dr. Hume may have mentioned, a remarkable situation that occurred in which a Jehovah's Witness, which, you know, is one of the Protestant sects that won't even permit transfusion of blood, permitted a transplantation under the provision that the blood be washed out of the donor kidney.

So, this is a situation which has even less objection than a simple transfusion from a religious sect. This is one of the ones who have been known to have objections to many common medical procedures, such as blood transfusions.

So, I find very little difficulty on this. Now, we have patients who are on home training and who are at home and having great difficulties because of either the economics of their home situation or the personal element of their home situation.

We have, for example, a patient whose only close relative who could assist in this, is having and did have preceding mental problems so his stability is very highly questionable and this man, obviously, is a functional person in government and has a very responsible job and would be much better off with a transplantation.

The statistical odds for matching him are greater, really, if you have a number of donors available and one of the reasons for setting

up this network as it happens, is to have a good match for those who need transplants and the larger the number of organs you have the more possible it is that you would have this match on him.

So, we are now, in our organization, attempting to gain a good tissue match, which requires an inventory of much more than you can use because, as in the tissue of the blood bank, if you have a great number of blood types on hand you are more likely to have the type you need right at the time you need it, and you will get a matched blood type and then maybe even save a life.

So, you have to have more organs than you can use in order to have a matching situation to solve these problems.

Senator GOODELL. I take it there has been obviously, a great number of persons who have died that could have been helped.

Dr. SCHREINER. Yes, indeed, because there is a severe limitation on the organ facilities and there is no way of sustaining these patients, really, on a large scale. We have no Government support now and no analysis facility in the District of Columbia which is available for use of residents and so, therefore, we really don't have the capability of saving large numbers of people. We can only carry patients on our dialysis and maybe carry them at home and this is a small number between the two universities.

I would say that we have possibly less than 30 and this is against an annual death rate of ideal young candidates under the age of 50 of more than 60 per million. We have here a metropolitan population of approximately 3 million in our area, so we are talking about 130 people a year outside when we are taking care of 20 to 30 and the rest of them die.

Senator GOODELL. Will you give us an idea of how many people there are right now in this area who are facing death unless they get organs?

Dr. SCHREINER. The figures aren't difficult to come by in the various jurisdictions, but they have been collected, and this might include foreign countries. Sweden has a total anatomical gift system and the figure is 60 per million which comes up as a more or less accurate figure for the most strict criteria that is available. That is, if you take the absolute strictest qualifications that anybody has ever put on an election program which are excessive, actually, for what we like to do, and assuming for a moment the very strictest criteria, then about 60 per million people have new cases and the other interesting thing that you should know about is that the District of Columbia has an annual death from kidney disease which is double the national average. We don't know exactly what that figure is, but if it follows the figure for the ideal cases that means that in proportion to the gross national figure we get 120 per million.

Senator GOODELL. 120 per million who are in need?

Dr. SCHREINER. Who die each year.

Senator GOODELL. Who die each year of kidney disease?

Dr. SCHREINER. Of kidney disease and there is another group which is at least three to four times as large who die of consequences of malignant hypertension.

Now, we have not been able to do anything about the larger potential pool of people with hypertension that exists because that is something that has to be refreshed in the future because we are not

even coming close to taking care of the people who have this medical need now.

Senator GOODELL. Are you saying then, based upon a statistical average, 360 people in the District of Columbia, right now this year, will die if they don't get a kidney transplant?

Dr. SCHREINER. That is a reasonable number, but it probably could be very much higher. There are many areas we can't go into because you don't delve into other areas when you are not taking care of the most immediate circle. You know, when penicillin was first introduced into the medical area right after the war there was very much limitation on penicillin and you could only treat pneumonia and other related diseases with penicillin, but now since there is so much penicillin available we use it on almost any kind of disease. So, you really have to be restricted within the area you have here and with this rigid outlook, perhaps as many as 360 per million. Senator GOODELL. How is that related to the number of kidney transplants that have taken place in the District of Columbia since 1959?

Dr. SCHREINER. Well, we have done a total of 17 transplants in 6 years so the number is supplemental.

Senator GOODELL. Is this primarily because you don't have donors of appropriate kidneys of the type to

Dr. SCHREINER. That is one of the reasons. This is a very complicated chain and any weak link in a chain closes up the-in other words, if you don't have any contrary capacity for this operation, then your probability of matching up the recipient goes down. But now, if you have a large inventory or population the possibility of getting a match goes up. And these two things mean that there are a number of people who are waiting for transplants and who are not getting them and just the same, we try to move the patients into transplantation, because if you don't, you will wind up with a traffic jam and nothing happens. We have been in a state of stagnation for months at a time. Senator GOODELL. Beyond passing this law, do you have any suggestions on how a nationwide effort for these donor cards can be promoted?

Dr. SCHREINER. The standard card would create interest in people and I think, of course, that some day we are going to have to create a better organization for delivery of the cards. As a result, we are really coping with a facility problem in an inadequate way.

At the present time this is a new kind of medical care and it is not really being properly used by our own institutions. I think our old. institutions are inadequate for this type of delivery.

Senator GOODELL. I would presume this could be promoted in a large number of ways. Physicians, I presume, would promote this with the cards available in their offices for people to sign.

Dr. SCHREINER. We are asking, of course, every practicing physician, at least, will have this first letter of March 9 and have some of these cards to distribute to anyone who asks for them.

In addition, we are trying to get whatever funds we can to help promote this activity for this type of widespread distribution.

Senator GOODELL. How many service clubs have been used in an effort to get these cards distributed? Have you used service clubs?